NRS-433V Research Critique and PICOT Question Guidelines- Final Draft

NRS-433V Research Critique and PICOT Question Guidelines- Final Draft

NRS-433V Research Critique and PICOT Question Guidelines- Final Draft

Quantitative and Qualitative Studies

            Diabetes mellitus, a metabolic disorder characterized by inappropriate sugar metabolism resulting from deficient insulin production or use, is the leading cause of cardiovascular diseases and a major nursing practice problem. Due to the recent surge in obesity and a sedentary lifestyle, diabetes mellitus has become a major menace in healthcare caused by a steady rise in prevalence and deaths as well. For instance, diabetes is the seventh leading cause of death in the US accounting for 5.2 deaths annually and the cases are deemed to rise soon (Glovaci et al., 2019). As a nursing practice problem, diabetes mellitus is complex in terms of management, leading to several complications and deaths, and the need for long-term management and follow-up which has proved expensive in terms of time and resources (Al-Sofiani et al., 2021). To reduce complications and improve quality of life, patients with diabetes require long-term follow-up with consistent contact with healthcare providers to adjust treatments and integrate education in care. However, contact was greatly limited during the surge of Covid 19, a situation that could worsen outcomes. Therefore, various interventions were proposed to improve access to care for patients with diabetes among them was the use of telemedicine. The purpose of this paper is to present a critical appraisal of two qualitative and quantitative studies on diabetes management during the Covid 19 outbreak and propose an evidence-based practice change.

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The PICOT question: In diabetic patients with uncontrolled sugars (P), how does the use of telemedicine (I) compare to usual outpatient visits (C) on reducing blood sugar and HbA1C (O) during Covid 19 outbreak (T)?

Background of Studies

Various studies to avail evidence-based practice to manage diabetes mellitus have been conducted including the two qualitative and quantitative studies included in this critique. The study by Onishi et al. (2022) aimed at comparing the effectiveness of either telemedicine or routine clinic visit on glycemic control as the main objective.  The research question stated: How does care using telemedicine compare to clinic visits on glycemic control during the covid era? Similarly, Wong et al. (2021), compared the changes in glycemic control of patients attending outpatient diabetic clinics versus telehealth consultation. The research question stated How does glycemic control differ between outpatient clinics and telehealth?  Relatably, the article by Al-Sofiani et al. (2019), the article focused on evaluating the experience and satisfaction levels of patients using telemedicine to offer diabetic care management during the pandemic. The study asserts that the use of telemedicine for routine care of individuals with diabetes increased during the pandemic in many nations and helped address the barriers to access to care. The objective of the article was to evaluate the effects of using telemedicine to improve diabetes care for patients with the problem. The research question stated: What is the experience and satisfaction of using telemedicine in diabetes care?

Finally, the article by Giani et al. (2021) addressed the professional experience of using technology including finding out the barriers and changes of using technology. The objective and purpose of the article entailed an assessment of these experiences and if there are challenges that require changes to improve care management. The research questions included “What is the HCP`s experience with using telemedicine? What are the challenges to implementation of telemedicine?”. This article like the previous ones demonstrates the impact of technology in improving access to care. As a result, nurses can use the information from these articles to leverage the use of technology in providing care to patients with chronic conditions, especially in the face of adversity and uncertainty.

Articles Supporting the Nursing Practice Problem

            The four articles present evidence that supports the PICOT question based on the interventions used and compared in the studies. My nursing problem addresses the management of diabetes and compares the effectiveness of telemedicine to the clinic visit Both articles evaluate the effectiveness of using telemedicine in the provision of care for diabetic patients. While The article by Al-Sofiani et al. (2019) presents the experiences and satisfaction of diabetic patients using telemedicine the study by Giani et al. (2021) describes the experiences of healthcare providers using telemedicine while caring for diabetic patients. Additionally, Imperatively, these articles support the nursing practice problem as they demonstrate the efficacy and relevance of telemedicine for both patients and providers to manage fluctuations in blood sugar levels for diabetic patients. Understanding the efficacy and relevance of telemedicine will enhance the adoption of technology to provide care to diabetic patients as well as other chronic conditions. Furthermore, as demonstrated by Wong et al. (2021), various telehealth services such as web-based appointments, messaging, smartphone apps, or phone calls can be used by nurses to communicate with patients and help in planning care as well as implementing care plans and offering long-term follow-up. Using telehealth improves health outcomes, improves access to care, increases patient satisfaction, and reduces healthcare costs.

Method of Studies

The articles under examination employ various methods to study the effects and use of telemedicine. For example, Al-Sofiani et al. (2019) is a qualitative study that utilized an online survey to gather patients’ experiences and level of satisfaction, while Giani et al. (2021) employed a cross-sectional electronic survey, which was distributed via social media and email and consisted of 34 questions. Online surveys are known for their speed and ability to quickly gather feedback, but they may not yield entirely honest responses. On the other hand, cross-sectional studies are beneficial in terms of targeting specific populations and generating accurate data, but they require more time and effort to assess the accuracy of the information provided by participants.

The quantitative studies presented in this research employed different research methods. Onishi et al. (2022) conducted a retrospective cohort study, which compared HbA1C levels before and after an emergency. Similarly, Wong et al. (2021) carried out a retrospective review study, which examined patients with diabetes managed through telehealth consultations in Sydney. Retrospective studies are utilized to investigate the relationship between a disease and its outcome. These studies have several benefits such as being cost-effective, less time-consuming, and practical. However, they also have certain limitations such as bias, confounding variables, recall bias, and missing data.

Results of Studies

The studies conducted by Onishi et al. (2022) and Wong et al. (2021) offer relevant and practical insights into nursing practice. Both studies found that telemedicine and standard clinic visits independently improved glycemic control in patients with diabetes. This supports the integration of telemedicine and in-person visits for managing chronic conditions to improve health outcomes. Additionally, Wong et al. (2021) found that telehealth consultations improved glycemic control and increased the number of consultations compared to in-person visits, highlighting the importance of telehealth in diabetes management during times of crisis. Giani et al. (2021) and Al-Sofiani et al. (2019) also found an increase in the use of telemedicine during the pandemic, with many healthcare providers expressing satisfaction with the benefits it provides for both patients and providers. However, implementation challenges such as data protection, reimbursement, and training costs were also noted. These studies suggest that healthcare providers, including nurses, should consider incorporating telemedicine into their practice to improve diabetes management and associated complications.

These studies have important implications for nursing practice. Firstly, they suggest that nurses should use technology to meet the Quadruple Aim of healthcare. Secondly, they emphasize the use of telemedicine as an innovative way to improve interactions between providers and patients in various settings. Finally, the studies highlight the need to integrate evidence-based practices to improve diabetes care management.

Ethical Considerations

It is crucial to consider ethical issues when researching to maintain credibility, and reliability and protect participants. Two important ethical considerations include obtaining informed consent and receiving approval from institutional review boards, and ensuring that participants are not harmed during the study (Mardani et al., 2019). Researchers should adhere to the principles of autonomy, beneficence, non-maleficence, and justice to ensure that the study is conducted ethically. Informed consent requires every participant to be informed about the risks and benefits of participating in research before agreeing to take part in a study voluntarily by signing off (Mardani et al., 2019). In the four articles, the researchers demonstrated this by obtaining permission from institutional review boards, gaining informed consent from participants, and ensuring that the study did not cause harm to the individuals who participated. The institutional review boards approved the study after these requirements were met.

Outcomes Comparison        

            My proposed PICOT question compares the effectiveness of telemedicine to outpatient visits in the management of diabetes mellitus. Several pieces of evidence as well as the four studies included in this critique have found the immense contribution of telemedicine in the management of chronic disease (Giani et al., 2021; Al-Sofiani et al., 2021; Onishi et al., 2022). Ranging from improved access to care to a reduction in cost, improved glycemic control, increased patient and healthcare providers` satisfaction, reduction in complications, and improved adherence to treatment are some of the positive contributions of telemedicine as evidenced by various studies. Similarly, I anticipate improved blood glucose control, enhanced access to care, reduction in admissions, improved patient well-being, enhanced adherence, and improved patient satisfaction by using telemedicine.

Proposed Evidence-Based Practice Change

            The research articles provide evidence that supports the incorporation of telemedicine into the care of patients with diabetes. Telemedicine enhances access to care, reduces the cost of care, and improves blood glucose control as well as patient well-being (Giani et al., 2021). This reduces the negative outcomes of diabetes and reduces mortality. Guided by the evidence provided, I see it feasible and relevant to incorporate telemedicine into care for diabetes patients in my facility. Through telemedicine, patient-nurse interaction will be enhanced as patients will be able to access remote care that is convenient, efficient, cost-effective, quality, and time-saving to enhance well-being. Additionally, telemedicine will upgrade the quality of care, enhance treatment adherence, reduce missed appointments, reduce hospital visits, and enhance patient knowledge.

Conclusion

            Healthcare providers improve their knowledge and skills for patient care through interaction with evidence-based information from credible sources that provide extensive information on how to address patient needs, especially for complex conditions such as diabetes. The information provided by the four articles supports the usefulness of using telemedicine in the management of diabetes. Therefore, nurses should adhere to evidence-based practice when offering care to improve patient outcomes.

References

Al-Sofiani, M. E., Alyusuf, E. Y., Alharthi, S., Alguwaihes, A. M., Al-Khalifah, R., & Alfadda, A. (2021). Rapid implementation of a Diabetes Telemedicine Clinic during the Coronavirus disease 2019 outbreak: Our protocol, experience, and satisfaction reports in Saudi Arabia. Journal of Diabetes Science and Technology, 15(2), 329–338. https://doi.org/10.1177/1932296820947094

Giani, E., Dovc, K., Dos Santos, T. J., Chobot, A., Braune, K., Cardona-Hernandez, R., De Beaufort, C., Scaramuzza, A. E., & ISPAD Jenious Group. (2021). Telemedicine and COVID-19 pandemic: The perfect storm to mark a change in diabetes care. Results from a worldwide cross-sectional web-based survey. Pediatric Diabetes, 22(8), 1115–1119. https://doi.org/10.1111/pedi.13272

Glovaci, D., Fan, W., & Wong, N. D. (2019). Epidemiology of diabetes mellitus and cardiovascular disease. Current Cardiology Reports, 21(4), 21. https://doi.org/10.1007/s11886-019-1107-y

Mardani, A., Nakhoda, M., Noruzi, A., & Shamsi Gooshki, E. (2019). Ethical considerations in the biomedical research: analysis of national biomedical research ethics guidelines in Iran. Journal of Medical Ethics and History of Medicine, 12, 4. https://doi.org/10.18502/jmehm.v12i4.767

Onishi, Y., Yoshida, Y., Takao, T., Tahara, T., Kikuchi, T., Kobori, T., Kubota, T., Shimmei, A., Iwamoto, M., & Kasuga, M. (2022). Diabetes management by either telemedicine or clinic visits improved glycemic control during the coronavirus disease 2019 pandemic state of emergency in Japan. Journal of Diabetes Investigation, 13(2), 386–390. https://doi.org/10.1111/jdi.13546

Wong, V. W., Wang, A., & Manoharan, M. (2021). The utilisation of telehealth for outpatient diabetes management during the COVID-19 pandemic: how did the patients fare? Internal Medicine Journal, 51(12), 2021–2026. https://doi.org/10.1111/imj.15441

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Prepare this assignment as a 1,500-1,750-word paper.

1. Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor. (I received 100% no feedback)

2. In the Topic 2 and Topic 3 assignments, you completed qualitative, quantitative, and mixed methods research critiques on two articles for each type of study (four articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions. (I received 100% no feedback)

3. The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

4. Use the “Research Critiques and PICOT Question Guidelines – Final Draft” document to organize your essay. Questions under each heading should be addressed as a narrative in the structure of a formal paper. Please note that there are two new additional sections: Outcomes Comparison and Proposed Evidence-Based Practice Change.

You are required to cite a minimum of three peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.

Please see below:

Topic 1: Literature Evaluation

Topic 2: Rough Draft…

Topic 3: Quantitative Research Critique II